Nutrition a Pressing Concern for Native Americans, Part II
Reversing a negative trend
by Gretchen Goetz

Editor's Note: This article is the second in a three-part series about health issues linked to nutritional problems in American Indian communities. The final installment will be in next month’s newsletter.

Tribal communities nationwide are working to fight the trend toward obesity and its resulting health consequences. Nutritionists such as Kahti DeWilde and Fran Miller work with tribes to educate members about proper diet and healthier lifestyles. In 2008, the Indian Health Service - a branch of the Department of Health and Human Services - reported almost 500 nutritionists working at the country's 561 federally recognized tribes.

Using Nutrition Assistance to Promote Healthy Foods
Some tribe nutritionists work as representatives for federal supplemental nutrition programs. Though AI/ANs make up 1.6 percent of the U.S. population, the "Federal Food Safety Net" covers a disproportionately high percentage of this demographic. In 2010, 13 percent of the U.S. population was enrolled in the Supplemental Nutrition Assistance Program (SNAP), formerly the food stamp program, whereas 24 percent of AI/AN households received SNAP benefits. AI/AN children, along with those who are both white and AI/AN, make up 2.8 percent of children enrolled in the National School Lunch Program, which supplements kids' school lunches. In 2008, just under 900,000 of these children were enrolled in the program, which serves the greatest number of Native Americans out of all federal nutritional assistance initiatives. AI/AN women and children participating in the Special Supplemental Assistance for Women, Infants and Children (WIC) represent 2.4 percent of program recipients. Of the Native American children ages 2-5 participating in WIC in 2008, more than 20 percent were obese.

DeWilde is the WIC coordinator for the Port Gamble tribe, where about one sixth of the tribal residents are enrolled in the program. The trick, she says, is persuading people to spend their vouchers on slightly more expensive but nutritious foods.

"One of my goals has been to really encourage them to use those foods stamps in healthier ways," she says. For example, "cut the soda out and the money you'll save on that you can actually put towards your produce or your healthier food options for calorie needs."

To teach people how to navigate the grocery store, DeWilde has an extensive collection of food packaging, from cereals boxes to frozen dinners to chip bags in her office that she uses to illustrate how to read nutrition labels.

The federal government last year announced plans to increase access to nutritious foods for participants of nutritional assistance programs and to promote healthy eating and active lifestyles among children through its Healthy Hunger Free Kids Act.

"These changes have the potential for enhancing the ability of USDA nutrition programs to serve children and their families in Indian Country," said the government's 2012 report on child nutrition in Indian communities. The full impact of these changes remains to be seen.

Recalling the Traditional Diet
Stressing the fact that healthy foods such as nuts, berries, vegetables and fish (in the case of Northwestern tribes) are a part of the original Native American diet is key in motivating people to shift to these more nutritious options, says Miller. "Our traditional plants program has been really popular," she says. The program teaches tribal members about plants traditional to both the Suquamish tribe itself and other tribes across the country, such as the "Three Sisters" vegetables: corn, beans and squash. It also emphasizes indigenous Northwest plants that can be gathered in the region. The effort to return to traditional foods is a national one.

"There's a whole native food sovereignty movement that is connecting a lot of native people today through newsletters and online forums. People are having meetings," says Harjo.

"They're saying 'Let's think how our ancestors did it before we got sick and what do we do to get back there?' "

Some tribes have buffalo herds now, and are reintroducing elk into their diets, she says.

DeWilde says she uses the traditional diet as a motivator for why people should eat more healthfully. "I just want to emphasize to Native Americans that in their past they used to eat off the land. When I bring that into the discussion there seems to be a better acceptance of 'Yes, it is true that we did eat a certain way back then and that our lifestyles have changed and as a result of it we're getting obese and we're getting diabetes.' "

Motivation Sparks Change
Another lesson DeWilde tries to instill is confidence in the positive effect of losing weight and eating more healthfully. One of her teaching tools is a pyramid-shaped rubbery yellow object with red flecks on it, about the size of a pint of liquid. This lump represents a pound of fat.

"When people come to me and say, 'I only lost a pound!' I say 'Well look how much a pound is!'" She explains.

Last year, the Port Gamble health services staff helped organize a community weight loss challenge. "That was the big, 'Let's jump on this. Let's get this tribe healthy,' " says DeWilde, who helped mentor participants. While many of the 100 who signed up for the 10-month challenge dropped out, DeWilde is proud of the 20 who stuck it out until the final weigh-in.

And she says the competition sparked an interest in weight loss among other tribal members. This year more than 15 people came together and started their own challenge, pooling some money together for a prize for the winner.

The Trickle-Up Effect: Starting from Early Childhood
Because trends toward obesity start at a young age among Native Americans, it's important to build a foundation for a healthy future early on.

Miller teaches weekly lessons at the local preschool. Children bring their enthusiasm about healthy eating home to their families, she says. "We're sending home tasting kits with the students so that there's a family involvement component," she explains. "I have a lot of parents and grandparents telling me that their kids are so excited. There are instructions for how to prepare the food and the whole family tastes them together."

Tribal leaders take nutrition and health very seriously. The mission statement of the Suquamish tribe is to provide for "the health, education and welfare of our families," and Miller says "they take that very seriously." The tribe has invested in 4 community gardens, as well as fresh food cooked from scratch for its high school students.

At the nearby Port Gamble reservation, one mom says the early childhood program motivated her family to start serving more fruits and veggies after her son came home raving about his fresh vegetable snacks there.

"My son won't eat canned vegetables any more," she says. "Me and my husband actually switched over to fresh produce." And, she says, she discovered that fresh produce is actually a bargain. "You can get 3 servings of fresh produce in comparison to canned vegetables."

Drawing on Community
Another asset that will work in American Indians' favor in the movement to improve nutrition is built into the very nature of thetribe: community.

"Traditionally, Native Americans put family and community above individual needs," explains Miller. "That cohesiveness is a real strength." Indeed DeWilde says the Port Gamble tribe's newsletter reaches about 6,000 people around the state.

"News like that, when it gets published, obviously a lot of people are going to hear about it." In the next issue? The story of a man who works at the health center who has diabetes and recently lost weight, got in shape and is now off all his medication.

Sharing success stories is a great way to inspire people, says Miller. Suquamish's Facebook page taps into the tradition of oral history with online narratives from tribal members sharing stories about why nutrition and health have played an important role in their lives.

© Food Safety News Reprinted with permission of the author. The original article appeared in Food Safety News on March 6, 2012

Submitted by Fran Miller, Suquamish Tribe Community Nutritionist

Kids love to help in the kitchen, and they love to eat the food that they have helped prepare. The recipes below are all healthy and feature fruits or vegetables in a rainbow of colors. They are simple enough for preschoolers to help with, or for older children to make on their own with a bit of supervision. Have fun in the kitchen with your child this month!

Bookworm Apple Bark
Grab your books and this crunchy, sweet breakfast treat as you dash off to school.

1 Granny Smith Apple
1 tablespoon peanut butter
2½ tablespoons raisins
1½ tablespoons dried sweetened cranberries

Instructions: Cut apple into four quar-ters, starting at the stem. Remove the core by cutting away to leave a flat surface on the apple quarter. Be careful not to cut too much of the edible portion of the apple away. Drop and slightly spread the peanut butter on apple quarters. Mix together the raisins and dried cranberries then sprinkle on peanut butter.
Serves: 1

Banana in a Blanket
1 (6 inch) whole wheat tortilla
1 tablespoon peanut butter
1 medium banana
1 teaspoon maple syrup or honey
1 tablespoon crunchy, nutty nugget cereal
Instructions: Lay tortilla on a plate. Spread peanut butter evenly on the tortilla. Sprinkle cereal over peanut butter.
Peel and place banana on the tortilla and roll the tortilla. Drizzle maple syrup or honey on top.
Optional: garnish with more cereal on top.
Serves: 1

Crazy, Curly Broccoli Bake
1½ cups whole wheat corkscrew pasta, dry
3 cups broccoli, frozen, chopped
1 10.5-oz.can low-fat cream of broc-coli soup, condensed
½ cup low fat milk
2 tablespoons plain bread crumbs
¼ teaspoon salt-free seasoning blend

Instructions: Preheat oven to 350F.
Cook pasta according to package di-rections. Place frozen broccoli in large microwave safe and oven proof dish and cook for 2 minutes on HIGH. Coarsely chop cooked broccoli. Mix soup with milk, and add to chopped broccoli.
Add cooked pasta and mix. Top with bread crumbs and seasoning blend. Bake in oven for 10-15 minutes until heated through.
Serves: 6

T-Rex Tortilla Pizza
2 seconds butter-flavored cooking oil spray
1 (6 inch) flour tortilla
1½ tablespoons mild salsa
½ cup frozen yellow corn, cooked
1½ tablespoons cooked chicken breast, shredded
1 tablespoon cheddar cheese, shredded
½ teaspoon dried chives

Instructions: Preheat oven to 400F.
Cook corn according to package in-structions. Spray cookie sheet with cooking oil. Place tortilla
on oiled sheet. Top with chicken, cooked corn, cheese, chives, and salsa. Bake for 10 minutes.
Cut in quarters and serve.
Serves: 1

Recipes are adapted from www.fruitsandveggiesmorematters.org